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—y n = Pein fer Sur je ral] Medical Reimbursement Vi hseleaal Aub S189. 315 tul esos ciensiore Ayablon Bemce CO LTD Seahoad Medical insurance PolcyNo \ 9% 99902 B pal ali dy ay PoventsNome Ammar dbyullah Washo alla patent's Age. Le ean et vane nee Patients Medical surance cad glo] | | O) oi[X)N{[6l| \1/5 & [ole] | vavelpatsheaLinastion mth Mobile No (Mandatorytovupdate yourdlsin tae) 050353 FR\S (esa a3 lida) allay Ematadcess: Or immow Ab yullalr ooh Edna Com pitti aut éserat | gyal upabiaesd Jaaollteid asi baad assis Total Others medication cost "Lab Cost Consultation Fee Dognosis Sig £5,—____ Tr lammatory oe — - dlseases of — ease ° —— prostate Detaled medical report Laboratory sults and ray reports iftheservice provided). | fasloasiale vavollysaa uta gd Asal jl jazaal ay ‘Ongina invoices ane recep of payments Sods ntl Jp! Copy tthe mecical surance cx gubllyuld ly yeue Copy of ext-re-entry Vs treatment ouside KSA), with alia yla yd eu laud Asigag Sap ayatopusli Yo 190 Tuniya acceptance letter (bool gts Note: Asin thats Reembursement of medial expenses wiley apply to Cases te glnopban dy git Lal pty able aay submitted within 30 days as specified in the policy NAasi9 99 aa.r0 90 le> og) 30 Lalas Very Important: ‘asta The claim payment will be through bank transfer only. sd gl usally) Jrsall Gis Ye Aula Alas Relat aly fe Cite es Crete T teceetoncibcbetic iain inion, gAsiN Ana hla Jala ay Ni acNdliegchete tig ™ ane tcwcordesinthetont) AMMAR ABDUILAH HASHLM faungslaynga sda tawiaconnnter 8\[A] 7 -2( 0 [2 (0) 0 2] \) 3lallo\ oldlolslld 449 Fe © [Suan suokcode VA} 8 0) PTT eats torktime SNB- Saud) National Bank Lata TheCompsnylorCoepestwelnuianceTamnya)wailtarierthwameunt—gisllslall ayaa sae Jipats yell gtoit 05 crpg BD stgar of the claunto the appticant’s bank account, as per the data provided above, Jord iy oll! Roato Aytloll cbigalt aio cay waldall pater yatall The Company does not held any egal esponubiy or facia alta gay Japs AU 08 RAR lai ph ip Aaya Ad apc ‘that may result due to the wrong bank transfer asa result of the applcant Aullellg penal GULyall ayadiy wallet ato golbill one Aol) aaghnls pond mace pron odvanl tomaton either bark (pauleduiagetanal CSS | "Aetonldpe ta thse iomationte cent and ude! my _ploshus gle pessaosta agent gus 0 regennbiy nome Hb Was Le ww Spun Oo os one aan 3/12 / 202)

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